BCACP Medication Management 4 — Questions and Answers
Question 1: A patient with atrial fibrillation and a CrCl of 28 mL/min needs anticoagulation. Which DOAC requires the most significant dose adjustment in this scenario?
- Rivaroxaban
- Apixaban
- Dabigatran (Correct answer)
- Edoxaban
Correct answer: Dabigatran
Dabigatran is 80% renally eliminated and is contraindicated or requires the most cautious use in severe renal impairment (CrCl <30 mL/min for AF indication).
Question 2: Which medication used in ambulatory care is most associated with causing drug-induced lupus?
- Amlodipine
- Hydralazine (Correct answer)
- Metoprolol
- Losartan
Correct answer: Hydralazine
Hydralazine is one of the most common causes of drug-induced lupus erythematosus, particularly in slow acetylators taking higher doses.
Question 3: A pharmacist reviews a prescription for clopidogrel in a patient on omeprazole. What is the clinical significance of this interaction?
- Omeprazole induces CYP2C19, increasing clopidogrel's active metabolite
- Omeprazole inhibits CYP2C19, reducing conversion of clopidogrel to its active metabolite (Correct answer)
- The interaction only applies to IV omeprazole formulations
- Omeprazole reduces clopidogrel absorption by raising gastric pH
Correct answer: Omeprazole inhibits CYP2C19, reducing conversion of clopidogrel to its active metabolite
Omeprazole inhibits CYP2C19, the enzyme responsible for converting clopidogrel to its active thiol metabolite, potentially reducing antiplatelet efficacy.
Question 4: Which monitoring parameter is most important 1-2 weeks after initiating an ACE inhibitor in a patient with bilateral renal artery stenosis?
- Blood pressure
- Serum creatinine and potassium (Correct answer)
- Liver function tests
- Complete blood count
Correct answer: Serum creatinine and potassium
ACE inhibitors can cause acute kidney injury and hyperkalemia in patients with bilateral renal artery stenosis due to loss of efferent arteriolar constriction, making renal function and electrolyte monitoring critical.
Question 5: A patient newly diagnosed with osteoporosis has a T-score of -3.1 at the hip. They are intolerant of oral bisphosphonates. Which therapy is most appropriate?
- Calcium and vitamin D supplementation only
- Calcitonin nasal spray
- Zoledronic acid 5 mg IV annually (Correct answer)
- Raloxifene 60 mg orally daily
Correct answer: Zoledronic acid 5 mg IV annually
Zoledronic acid is a first-line IV bisphosphonate option that offers annual dosing with proven fracture reduction benefit, appropriate for patients intolerant of oral formulations.
Question 6: Which adverse effect is most commonly associated with the use of inhaled corticosteroids in ambulatory asthma patients?
- Adrenal suppression
- Oropharyngeal candidiasis (Correct answer)
- Hyperglycemia
- Osteoporosis
Correct answer: Oropharyngeal candidiasis
Oropharyngeal candidiasis is the most common local adverse effect of inhaled corticosteroids, mitigated by rinsing the mouth after each use.
Question 7: A patient on lithium is started on ibuprofen for knee pain. Which monitoring parameter should be checked within the next 5-7 days?
- Thyroid function tests
- Serum lithium level (Correct answer)
- Complete blood count
- Liver function tests
Correct answer: Serum lithium level
NSAIDs reduce renal prostaglandin synthesis, decreasing renal lithium clearance and potentially raising lithium levels to toxic concentrations.
BCACP Medication Management 4
A patient with atrial fibrillation and a CrCl of 28 mL/min needs anticoagulation.
Which DOAC requires the most significant dose adjustment in this scenario?